Prevalence of and factors associated with stenotic thoracic ligamentum flavum hypertrophy

• Published in: Regional anesthesia and pain medicine Vol. 49; no. 5; pp. 326 - 331
• Main Authors: Kim, Chan-Sik, Kim, Hyungtae, Kim, Sehee, Lee, Ju Hwan, Jeong, Koun, Lee, Hyun Seung, Kim, Yeon-Dong
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01-05-2024; BMJ Publishing Group LTD
• Subjects: Adult; Age; Age Factors; Aged; Aged, 80 and over; Anesthesiology; Asymptomatic; Back Pain; Chronic and interventional pain; Clinical medicine; Degenerative disc disease; Diagnostic Techniques and Procedures; Epidemiology; Female; Humans; Hypertrophy; Ligamentum Flavum - diagnostic imaging; Ligamentum Flavum - pathology; Magnetic Resonance Imaging; Male; Medical diagnosis; Medicine; Middle Aged; Multimodal Imaging; Pain Management; Patients; Prevalence; Regional anesthesia; Retrospective Studies; Risk Factors; Spinal stenosis; Spinal Stenosis - diagnostic imaging; Spinal Stenosis - epidemiology; Thoracic Vertebrae - diagnostic imaging; Thoracic Vertebrae - pathology; South Korea; Back Pain; Multimodal Imaging; Diagnostic Techniques and Procedures; Epidemiology; Pain Management
• ISSN: 1098-7339; 1532-8651
• DOI: 10.1136/rapm-2023-104692

IntroductionStenotic thoracic ligamentum flavum hypertrophy can cause leg and/or low back pain similar to that caused by lumbar spinal stenosis. However, the thoracic spine may occasionally be overlooked in patients with leg and/or low back pain. An accurate understanding of the prevalence of stenotic thoracic ligamentum flavum hypertrophy and its associated factors is necessary.MethodsIn this prevalence study, we reviewed whole-spine MRI scans of patients who visited the pain clinic complaining of leg and/or low back pain between 2010 and 2019. We analyzed the overall prevalence and prevalence according to the age group, sex, grade of lumbar disc degeneration, and thoracic level. In addition, we identified factors independently associated with stenotic thoracic ligamentum flavum hypertrophy occurrence.ResultsAmong 1896 patients, the overall prevalence of stenotic thoracic ligamentum flavum hypertrophy was 9.8% (185/1896), with the highest prevalence observed in the ≥80-year-old age group among all age groups (15.9%, 14/88). The region with the highest prevalence was the T10/11 level (3.0%, 57/1896). Multivariable logistic regression analysis revealed that when compared with the <50-year-old age group, all other age groups were significantly associated with stenotic thoracic ligamentum flavum hypertrophy (p<0.01). In addition, grade 5 of lumbar disc degeneration was significantly associated with stenotic thoracic ligamentum flavum hypertrophy (p=0.03).ConclusionsGiven the possibility for missed stenotic thoracic ligamentum flavum hypertrophy to potentially result in neurological complications, extending lumbar spine MRI covering the lower thoracic region may be considered for patients over 50 years of age with suspected severe lumbar disc degeneration.